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Krankenkassenwettbewerb in der GKV: Evidenz für Risikoselektion?

Listed author(s):
  • Robert Nuscheler

In 1996, free choice of sickness fund was given to those insured under the German Public Health Insurance System, thus significantly intensifying competition among funds. As funds must not charge risk-related premiums (community rating), there are substantial selection incentives, i.e. funds have incentives to engage in active risk selection to improve their risk pool. In this paper we argue that the distortions observed in the German Public Health Insurance market do not originate from active but from passive risk selection. Thus, the problem is not competition but its insufficient organization. Improved risk adjustment would mitigate this problem and would, additionally, allow for more competition on the market. Seit 1996 können die Versicherten in der gesetzlichen Krankenversicherung Deutschlands (GKV) ihre Krankenkasse frei wählen. Der Wettbewerb zwischen den Kassenwurde damit erheblich verstärkt. Wegen des Verbots risikoabhängiger Prämien (Diskriminierungsverbot) haben die Krankenkassen einen Anreiz, aktiv Risikoselektion zu betreiben - sich also aktiv um eine Verbesserung ihres Risikopools zu bemühen. In diesem Beitrag wird argumentiert, dass die Wettbewerbsverzerrungen in der GKV nicht auf aktive, sondern auf passive Risikoselektion zurückzuführen sind. Das Problem liegt also nicht im Wettbewerb selbst, sondern in der schlechten Organisation des Wettbewerbs. Ein verbesserter Risikostrukturausgleich würde dieses Problem entschärfen und zudem eine weitere Stärkung des Wettbewerbs ermöglichen.

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Article provided by DIW Berlin, German Institute for Economic Research in its journal Vierteljahrshefte zur Wirtschaftsforschung.

Volume (Year): 73 (2004)
Issue (Month): 4 ()
Pages: 528-538

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Handle: RePEc:diw:diwvjh:73-40-4
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  1. Johannes Schwarze & Hanfried H. Andersen, 2001. "Kassenwechsel in der gesetzlichen Krankenversicherung: welche Rolle spielt der Beitragssatz?," Discussion Papers of DIW Berlin 267, DIW Berlin, German Institute for Economic Research.
  2. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, Oxford University Press, vol. 90(4), pages 629-649.
  3. Stefan Greß, 2002. "Freie Kassenwahl und Preiswettbewerb in der GKV: Effekte und Perspektiven," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 71(4), pages 490-497.
  4. Buchner, Florian & Wasem, Jurgen, 2003. "Needs for further improvement: risk adjustment in the German health insurance system," Health Policy, Elsevier, vol. 65(1), pages 21-35, July.
  5. Andreas Werblow, 2002. "Alles nur Selektion?: Der Einfluss von Selbstbehalten in der Gesetzlichen Krankenversicherung," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 71(4), pages 427-436.
  6. Martin Schellhorn, 2002. "Auswirkungen wählbarer Selbstbehalte in der Krankenversicherung: Lehren aus der Schweiz?," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 71(4), pages 411-426.
  7. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
  8. Buchmueller, Thomas C. & Feldstein, Paul J., 1997. "The effect of price on switching among health plans," Journal of Health Economics, Elsevier, vol. 16(2), pages 231-247, April.
  9. Kifmann, Mathias, 2002. "Community rating in health insurance and different benefit packages," Journal of Health Economics, Elsevier, vol. 21(5), pages 719-737, September.
  10. Robert Nuscheler & Thomas Knaus, 2005. "Risk selection in the German public health insurance system," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1253-1271.
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